- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,409.10 / $17,122.59 / $28,657.20
| Facility | | $12,409.10 | $17,122.59 | $28,657.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,342.29 / $25,342.29 / $25,342.29
| Facility | | $25,342.29 | $25,342.29 | $25,342.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.00 / $19,861.86 / $30,716.72
| Facility | | $2,423.00 | $19,861.86 | $30,716.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,700.63 / $19,263.66 / $32,305.05
| Facility | | $12,700.63 | $19,263.66 | $32,305.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $15,546.84 / $34,570.19
| Facility | | $2,600.00 | $15,546.84 | $34,570.19 |